Substance use is associated with an increased risk of adolescent firearm homicide.

Drug and alcohol use at the individual, family, and neighborhood levels is associated with increased odds of adolescent firearm homicide, according to a study published in JAMA Internal Medicine.

Almost all adolescent homicides in Philadelphia between 2010 and 2012 were committed with a firearm. Therefore, Bernadette C. Hohl, PhD, MPH, from the Department of Epidemiology, School of Public Health at Rutgers University, and colleagues sought to determine the relationship between the exposure to drugs and alcohol and adolescent firearm homicide to inform new approaches to prevent firearm violence.

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The study included data identified from police and medical examiner's reports of all 13- to 20-year-olds who were homicide victims in Philadelphia between January 2010 and December 2012. The researchers included 161 adolescent homicide cases, 97.5% of which were firearm homicide cases, and 172 matched controls, 96.5% of which were firearm homicide controls. They examined individual, family, and neighborhood drug and alcohol use and controlled for age, race, school suspensions, arrests, and neighborhood ethnicity.

The results showed that adolescents who had a history of alcohol use or drug use had an increased risk of firearm homicide (adjusted odds ratio [AOR], 4.1 and 4.4, respectively). In addition, adolescents whose caregiver had a history of drug use had an increased risk of firearm homicide (AOR, 11.7). Adolescents who lived in neighborhoods with high densities of alcohol outlets and moderate or high drug availability also had an increased risk (AOR, 3.2 and 3.4, respectively).

“Our findings suggest that public health approaches to prevent firearm homicides among adolescents should address risk factors for violence at multiple levels,” the study authors wrote. “The oldest and most tested approaches to reducing youth violence focus on changing individual behavior and family environments.

“Multi-level approaches should form the basis for future research and interventions to reduce the burden of firearm violence that disproportionately affects adolescents in minority populations in large US cities.”